Migrating opiate pump: A typical cause of meralgia paresthetica

Abstract

This is a case report of a 60 year-old female who presented with pain on the anterolateral aspect of her right thigh. The patient had a history of placement of a Drug Administration System (DAS, Opiate pump) in August, 1998 for chronic lumbar radiculopathy and a multiply operated on spine which she had suffered with since October, 1991. She presented with the sub-acute onset of focal pain on the anterior aspect of her right superior iliac crest region and dysesthesias on the anterotateral aspect of her right thigh. There was no history of recent trauma, worsening low back pain, or any other sensori-motor change. There was no history of anterior iliac crest bone graft for her spinal fusion and she had no anterolateral thigh symptoms related to her lumbar radiculopathy. Her neurological examination was significant only for decreased sensation on the anterolateral aspect of her right thigh. On abdominal examination the DAS pump was found at a low-lying location and was closely abutting the anterior and medial aspect of her superior iliac spine. She underwent revision of the DAS pump site with obliteration of the inferior and lateral aspect of the pump pocket. Her symptoms improved by 30% immediately and completely dissipated within two month following the procedure. This is the first reported case of lateral femoral cutaneous nerve neuropathy with DAS use. Recognition of focal compressive neuropathy by distal migration of a DAS is important, as they are potentially treatable with recognition.